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Background Intergenerational programmes are formal activities bringing different generations together and have been identified as a way to help people living with dementia to stay socially connected. While there is some evidence from individual studies as to their benefits, there is no overall coherent account as to the perceptions and experiences of participants who engage in such programmes. This review synthesises qualitative evidence of the experiences and perceptions of young people and older people living with dementia of participating in such programmes. Methods We searched EBSCO CINAHL, OVID Medline, Embase, Ovid PsycINFO, the Web of Science, Epistemonikos and grey literature sources. We used thematic synthesis to analyse and synthesise the evidence in to four themes, with 11 key findings. We assessed our confidence in each of these findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. Findings Our review highlights the potential enjoyment for young people and older people living with dementia when participating in Intergenerational programmes, despite some initial trepidation. These programmes provide an opportunity to establish and develop relationships and for young people to learn about dementia, ageing and how to interact with older people living with dementia. However, it is important to have staff facilitators present to provide reassurance to both groups. It is also important to take the personal preferences of participants into account and to be considerate of noise levels and other aspects of programme delivery that may inhibit engagement. Conclusion This is the first qualitative evidence synthesis specifically exploring Intergenerational programmes aimed at older people living with dementia. We provide insights into the perspectives of those who have participated in Intergenerational programmes. It is important to consider these views, together with other evidence of effectiveness, when planning Intergenerational programmes. While our review is limited by a small number of studies from only a few countries, we have moderate to high confidence in our findings. Further research into the development of Intergenerational programmes specifically tailored for people living with dementia is needed. The findings also provide guidance for people planning to deliver or design future Intergenerational programmes.

BACKGROUND: Thoracoabdominal aortic aneurysms (TAAAs) are a life‐threatening condition which remain difficult to treat. Endovascular and open surgical repair (OSR) provide treatment options for patients, however, due to the lack of clinical trials comparing these, the optimum treatment option is unknown. OBJECTIVES: To assess the effectiveness and safety of endovascular repair versus conventional OSR for the treatment of TAAAs. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 26 April 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations. SELECTION CRITERIA: We considered all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing endovascular repair to OSR for TAAAs for inclusion in the review. The main outcomes of interest were prevention of aneurysm rupture (participants without aneurysm rupture up to 5 years from intervention), aneurysm‐related mortality (30 days and 12 months), all‐cause mortality, spinal cord ischaemia (paraplegia, paraparesis), visceral arterial branch compromise causing mesenteric ischaemia or renal failure, and rate of reintervention. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all titles and abstracts identified from the searches to identify those that met the inclusion criteria. We planned to undertake data collection, risk of bias assessment, and analysis in accordance with Cochrane recommendations. We planned to assess the certainty of the evidence using GRADE. MAIN RESULTS: No RCTs or CCTs met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of endovascular compared to OSR in patients with TAAAs and are unable to provide any evidence on the optimal surgical intervention for this cohort of patients. High‐quality RCTs or CCTs addressing this objective are necessary, however conducting such studies will be logistically and ethically challenging for this life‐threatening disease.

Background In December 2019, an outbreak of novel corona virus pneumonia occurred in Wuhan City, China, and spread throughout the whole of country in a short period. Figures from China’s National Health Commission show that more than 3300 health care workers have been infected as of early March. In Italy, 20% of responding health care professionals was infected, and some have died. Health care professionals are exposed to different types of stress both physical and psychological in response to this serious infectious public health event. Research aims The aim of this study is to measure the degree of mental stress among front line health care workers dealing with COVID-19 patients. Methods We conducted the study through online survey questionnaire after obtaining the ethics approval from the Research Ethics Committee of Galway University Hospital in Ireland (Ref: C.A. 2355). All personal information of the medical staff involved in the survey has been kept confidential. Results Three hundred nine health care members (209 male and 97 female) have agreed to participate in our survey from different hospitals and different specialties all over the world. Overall PSS Score: mean 19.42 (Standard Deviation ± 5.876, range 1–33). Frontline health care workers working in University Hospitals and tertiary referral centres had lower levels of stress compared to those working in peripheral hospitals (P = 0.007, Kruskal Wallis). Conclusion The COVID-19 pandemic is one of the most stressful events that a health care worker may face during his life time. Most of the participants in the survey developed a moderate degree of stress.

Background: There is an increased risk with advancing age that degenerative conditions such as dementia will affect a person's capacity to communicate. Thus, there is increased possibility that nursing students will be caring for this client group and will need to have the skills to communicate effectively. The Validation, Emotion, Reassure, Activity (VERA) framework is a communication tool developed for this purpose. Objectives: This pilot study explored nursing students' perceptions and experiences of communicating with people with dementia incorporating the VERA communication skills framework. Methods: Using a descriptive qualitative approach, second year undergraduate general nursing students were eligible for inclusion if they were assigned to complete their 4-week clinical placement in the designated research site and were willing to participate. Students allocated to the designated research site (n= 6) in semester 1 received standard communication skills as part of the undergraduate programme and students allocated (n= 10) in semester 2 received 2.5 h of additional communication skills based on the VERA framework. Data were analysed using framework analysis as described by Ritchie & Spencer. Results: The findings showed that students in both groups had initial reservations about communicating with people living with dementia. They employed several strategies including nonverbal techniques, distraction, reminiscence and life story work. However, students who received the VERA communication training felt more prepared to engage in these strategies because of the VERA training. Conclusion: With increasing numbers of people with dementia accessing health care, it is crucial that future nursing staff are equipped to meet the specific care needs of this population; which includes effective communication. The VERA framework can be useful to structure communication for nursing students. Implication for practice: The VERA training may be considered a useful framework for increasing undergraduate nursing students' knowledge and confidence in advance of clinical placements in older person's services. Nursing staff should continue to support students on clinical placements which involve caring for people with dementia and be cognisant of the trepidation students may have when first meeting this client group.

BACKGROUND: Type B aortic dissection can lead to serious and life‐threatening complications such as aortic rupture, stroke, renal failure, and paraplegia, all of which require intervention. Traditionally, these complications have been treated with open surgery. Recently however, endovascular repair has been proposed as an alternative. OBJECTIVES: To assess the effectiveness and safety of thoracic aortic endovascular repair versus open surgical repair for treatment of complicated chronic Type B aortic dissection (CBAD). SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and AMED databases, as well as the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers, to 2 August 2021. We searched references of relevant articles retrieved through the electronic search for additional citations. SELECTION CRITERIA: We considered all randomised controlled trials (RCTs) and controlled clinical trials (CCTs) assessing the effects of thoracic aortic endovascular repair (TEVAR) versus open surgical repair (OSR) for treatment of complicated chronic Type B aortic dissection (CBAD). Outcomes of interest were mortality (all‐cause, dissection‐related), neurological sequelae (stroke, spinal cord ischaemia/paresis‐paralysis, vertebral insufficiency), morphological outcomes (false lumen thrombosis, progression of dissection, aortic diameters), acute renal failure, ischaemic symptoms (visceral ischaemia, limb ischaemia), re‐intervention, and health‐related quality of life. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all titles and abstracts identified by the searches to identify those that met the inclusion criteria. From title and abstract screening, we did not identify any trials (RCTs or CCTs) that required full‐text assessment. We planned to undertake data collection and analysis in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to assess the certainty of evidence using GRADE. MAIN RESULTS: We did not identify any trials (RCTs or CCTs) that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: Due to lack of RCTs or CCTs investigating the effectiveness and safety of TEVAR compared to OSR for patients with complicated CBAD, we are unable to provide any evidence to inform decision‐making on the optimal intervention for these patients. High‐quality RCTs or CCTs addressing this objective are necessary. However, conducting such studies will be challenging for this life‐threatening disease.

Background Randomized trials are designed to evaluate the effects of health care interventions. The recruitment process in a randomized trial can be challenging. Poor recruitment can have a negative impact on the allocated budget and estimated completion date of the study and may result in an underpowered research that will not adequately answer the original research question. Aim We aim to perform a Study Within A Trial (SWAT) to evaluate the impact of same-day consent or delayed consent on recruitment and retention in the host trial. Methods This SWAT is designed as an observational study. However, the host trial is a randomized controlled trial evaluating the effectiveness of an intensive lifestyle modification program in patients with peripheral arterial disease. For this trial and SWAT, same-day consent is defined as the patient giving consent on the same day, after the investigator has fully explained the predesigned information leaflet for the host trial. Delayed consent is defined as the patient feeling they still need further time to consider their decision to participate or not. Swat registration The SWAT was registered on the Northern Ireland Network for Trials Methodology Research.

The impact of reduced adherence in randomized clinical trials is well documented in the literature. Nonadherence can negatively affect the trial sample size and estimation of the treatment effect. This protocol aims to evaluate the effects of a telephone call reminder on the adherence rates of participants to interventions in a cardiovascular randomized trial. This is a study within a trial (SWAT). The host trial is evaluating the effectiveness of a multidisciplinary 16-wk cardiovascular disease prevention program on risk factor profile among patients with carotid artery stenosis. Simultaneously, this SWAT will evaluate the effectiveness of telephone call reminders on the participants' adherence to the host trial intervention. The primary outcome is adherence to the protocol of the host trial. Secondary outcomes are level of adherence, number of dropouts, and time to drop out from the host trial.

Background Developed by Blackhall et al. (2011), the Validation, Emotion, Reassure, Activity (VERA) communication framework seeks to provide student nurses with a guide to provide person-centred care to people living with dementia. The framework aims to enable the caregiver to communicate with the person living with dementia in a respectful manner, and accept that there is both value and meaning to the person’s speech and behaviour. This paper presents the findings from a small pilot control pre-post study which aimed to explore the impact of the VERA framework to promote person-centred communication between student nurses and older people with dementia in long term care. Methods A control group of six students, received standard communication training and ten students received additional communication training using the VERA framework. Data was collected using the non-participant observational tool Quality of Interactions Schedule (QUIS) and three self-assessment questionnaires to assess student nurses’ confidence, dementia knowledge and communication skills. Results The results of this study found that those students who received the additional VERA communication training were observed to have a significantly (Mann-Whitney U test; p = Conclusion The study finding need to be interpreted with caution given the small sample size and the pilot nature of the study. Nevertheless, these findings indicate that the VERA framework has the potential to improve (1) person-centred communication between student nurses and older people with dementia and (2) students’ confidence to care for people with dementia.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of mobile health technologies to improve walking distance in people with intermittent claudication.

Background Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease. Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study, we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors. Methods This is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events. Discussion This study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high-quality, well-powered clinical trial. Trial registration This trial was registered (11/07/2017) on the European Clinical Trials Database (EudraCT number 2017-002964-41) and ClinicalTrials.gov (NCT03935776) which was registered on 02 May 2019.

Cervical artery dissection (CeAD) is a pathological bleed or tear, or both, in the wall of the carotid or vertebral arteries as they course through the neck, and is a leading cause of stroke in young people.To assess the effectiveness of surgical and radiological interventions versus best medical treatment alone for treating symptomatic cervical artery dissection.We performed comprehensive searches of the Cochrane Stroke Group Trials Register (last searched March 2020), the Cochrane Central Register of Controlled Trials (CENTRAL), 2020, Issue 4, in the Cochrane Library (searched March 2020), MEDLINE (1946 to March 2020) and Embase (1974 to March 2020). We searched relevant ongoing trials and research registers (searched March 2020), checked references in all relevant papers for additional eligible studies, and contacted authors and researchers in the field.Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of either surgical or endovascular intervention for the management of symptomatic CeAD were eligible for inclusion. Only studies with anticoagulants or antiplatelet treatment as the control group were included. Two review authors planned to independently extract data.Primary outcomes were ipsilateral stroke and disability. Secondary outcomes were death, any stroke, or transient ischaemic attack, residual stenosis (50%), recurrence of cervical dissection, expanding pseudoaneurysm, or major bleeding. We analysed the studies according to the first choice of treatment. We planned to assess for risk of bias and apply GRADE criteria for any included studies.We did not find any completed RCTs or CCTs undertaken in this area of research.No RCTs or CCTs compared either surgery or endovascular therapy with control. Thus, there is no available evidence to support their use for the treatment of extracranial cervical artery dissection in addition to antithrombotic therapy in people who continue to have neurological symptoms when treated with antithrombotic therapy alone.پیشینه: دایسکسیون شریان گردنی (cervical artery dissection; CeAD)، خونریزی یا پارگی پاتولوژیک، یا هر دو، در دیواره شریان‌های کاروتید یا ورتبرال است که از گردن عبور می‌کنند، و دلیل اصلی سکته مغزی در جوانان محسوب می‌شوند. اهداف: ارزیابی اثربخشی مداخلات جراحی و رادیولوژیکی در برابر بهترین درمان دارویی به‌تنهایی برای درمان دایسکسیون علامت‌دار شریان گردنی. روش‌های جست‌وجو: جست‌وجوهای جامعی را در پایگاه ثبت کارآزمایی‌های گروه استروک در کاکرین (که آخرین‌بار در مارچ 2020 جست‌وجو شد)؛ پایگاه ثبت مرکزی کارآزمایی‌های کنترل شده کاکرین (CENTRAL)، شماره 4؛ سال 2020، در کتابخانه کاکرین (در مارچ 2020 جست‌وجو شد)؛ MEDLINE (1946 تا مارچ 2020) و Embase (1974 تا مارچ 2020) انجام دادیم. کارآزمایی‌های در حال انجام مرتبط و پایگاه‌های ثبت پژوهش را جست‌وجو کردیم (در مارچ 2020)، منابع را در تمام مقالات مرتبط برای یافتن مطالعات واجد شرایط بیشتر بررسی کردیم، و با نویسندگان و محققان در این زمینه تماس گرفتیم. معیارهای انتخاب: کارآزمایی‌های تصادفی‌سازی و کنترل شده (randomised controlled trials; RCTs) و کارآزمایی‌های بالینی کنترل شده (controlled clinical trials; CCTs) از مداخله جراحی یا اندوواسکولار برای مدیریت CeAD علامت‌دار برای ورود واجد شرایط بودند. فقط مطالعات انجام شده با درمان آنتی‌کوآگولانت‌ها یا آنتی‌پلاکت به‌عنوان گروه کنترل وارد شدند. دو نویسنده مستقل از هم به استخراج داده‌ها پرداختند. گردآوری و تجزیه‌وتحلیل داده‌ها: پیامدهای اولیه سکته مغزی یک‐‌طرفه و ناتوانی بودند. پیامدهای ثانویه عبارت بودند از مرگ‌ومیر، هرگونه سکته مغزی، یا حمله ایسکمیک گذرا، تنگی باقیمانده (50%)، عود دایسکسیون گردنی، گسترش آنوریسم کاذب (pseudoaneurysm)، یا خونریزی ماژور. مطالعات را با توجه به اولین انتخاب درمان تجزیه‌وتحلیل کردیم. برای ارزیابی خطر سوگیری (bias) برنامه‌ریزی کردیم و معیار درجه‌‏بندی توصیه‏، ارزیابی، توسعه و ارزشیابی (GRADE) را برای هر مطالعه وارد شده به کار بردیم. نتایج اصلی: هیچ RCT یا CCT کامل ‌شده‌ای را در این زمینه پژوهشی پیدا نکردیم. نتیجه‌گیری‌های نویسندگان: هیچ RCT یا CCT به مقایسه جراحی یا درمان اندوواسکولار با کنترل نپرداخت. بنابراین، هیچ شواهدی وجود ندارد که بتوان بر اساس آنها از استفاده از این درمان‌ها برای درمان دایسکسیون شریان گردنی خارج جمجمه‌ای به همراه درمان آنتی‌ترومبوتیک در افرادی که با وجود درمان با داروهای آنتی‌ترومبوتیک به‌تنهایی، هم‌چنان نشانه‌های عصبی (نورولوژیکی) دارند، حمایت کرد.บทนำ: การฉีกเซาะของผนังหลอดเลือดแดงที่คอ (Cervical artery dissection; CeAD) คือ การเกิดเลือดออกหรือฉีกขาดหรือทั้งสองอย่างในผนังของหลอดเลือดแดง carotid หรือ vertebral ที่อยู่บริเวณลำคอ และเป็นสาเหตุสำคัญของโรคหลอดเลือดสมองในคนอายุน้อย วัตถุประสงค์: เพื่อประเมินประสิทธิผลของการผ่าตัดและการสวนหลอดเลือดเทียบกับการให้ยาที่ดีที่สุดเพียงอย่างเดียวสำหรับการรักษาภาวะการฉีกเซาะของผนังหลอดเลือดแดงที่คอที่มีอาการ วิธีการสืบค้น: ผู้วิจัยทำการสืบค้นอย่างครอบคลุมใน Cochrane Stroke Group Trials Register (สืบค้นครั้งล่าสุดในเดือนมีนาคม 2020), Cochrane Central Register of Controlled Trials (CENTRAL), 2020, Issue 4, ใน Cochrane Library (สืบค้นเมื่อมีนาคม 2020), MEDLINE (1946 ถึงมีนาคม 2020) และ Embase (1974 ถึงมีนาคม 2020) นอกจากนี้ยังค้นหาการทดลองที่เกี่ยวข้องที่กำลังดำเนินการอยู่และแบบลงทะเบียนการวิจัย (สืบค้นเมื่อมีนาคม 2020), ตรวจสอบรายการอ้างอิงในการศึกษาที่เกี่ยวข้องทั้งหมดเพื่อหาการศึกษาที่เข้าเกณฑ์เพิ่มเติม และติดต่อผู้เขียนและนักวิจัยในสาขานั้น เกณฑ์การคัดเลือก: การศึกษาที่เข้าเกณฑ์คัดเลือกคือ การทดลองแบบ randomised controlled trials (RCTs) และ controlled clinical trials (CCTs) ของการผ่าตัดหรือการสวนหลอดเลือดสำหรับการรักษา CeAD ที่มีอาการ และสนใจเฉพาะการศึกษาที่มีกลุ่มควบคุมเป็นการให้ยาต้านการแข็งตัวของเลือดหรือยาต้านเกล็ดเลือด ผู้ทบทวนววรณกรรม 2 คนต่างดึงข้อมูลอย่างเป็นอิสระต่อกัน การรวบรวมและวิเคราะห์ข้อมูล: ผลลัพธ์หลัก ได้แก่ โรคหลอดเลือดสมองในข้างที่มีพยาธิสภาพของหลอดเลือด และภาวะทุพพลภาพ ผลลัพธ์รอง ได้แก่ การเสียชีวิต, โรคหลอดเลือดสมองใดๆ, หรือภาวะ transient ischaemic attack, การตีบของหลอดเลือดที่เหลืออยู่ (50%), การกลับเป็นซ้ำของการฉีกเซาะของหลอดเลือด, expanding pseudoaneurysm, หรือการมีเลือดออกที่รุนแรง ผู้วิจัยได้วิเคราะห์การศึกษาตามตัวเลือกแรกของการรักษา และวางแผนที่จะประเมินความเสี่ยงของอคติและใช้เกณฑ์ GRADE สำหรับการศึกษาใดๆ ที่นำมาประเมิน ผลการวิจัย: ผู้วิจัยไม่พบ RCT หรือ CCT ที่สมบูรณ์ที่ศึกษาในหัวข้อการวิจัยนี้ ข้อสรุปของผู้วิจัย: ไม่มี RCTs หรือ CCTs ที่เปรียบเทียบการผ่าตัดหรือการสวนหลอดเลือดกับการรักษามาตรฐาน ดังนั้น จึงยังไม่มีหลักฐานสนับสนุนการใช้วิธีดังกล่าวในการรักษาภาวะการฉีกเซาะของผนังหลอดเลือดแดงที่คอเพิ่มเติมจากการให้ยาต้านเกร็ดเลือดในผู้ที่ยังคงมีอาการทางระบบประสาทเมื่อได้รับยาต้านเกร็ดเลือดเพียงอย่างเดียว.La dissection des artères cervicales (DAC) est un saignement ou une déchirure pathologique, ou les deux, dans la paroi des artères carotides ou vertébrales lorsqu'elles traversent le cou, et est une cause majeure d'accident vasculaire cérébral chez les jeunes.Évaluer l'efficacité des interventions chirurgicales et radiologiques par rapport au meilleur traitement médical seul pour traiter la dissection symptomatique des artères cervicales. STRATÉGIE DE RECHERCHE DOCUMENTAIRE: Nous avons effectué des recherches exhaustives dans le registre des essais du groupe Cochrane sur les accidents vasculaires cérébraux (dernière recherche en mars 2020), dans le registre Cochrane des essais contrôlés (CENTRAL), 2020, numéro 4, dans la Bibliothèque Cochrane (recherche en mars 2020), dans MEDLINE (1946 à mars 2020) et dans Embase (1974 à mars 2020). Nous avons recherché les essais pertinents en cours et les registres de recherche (recherche effectuée en mars 2020), vérifié les références dans tous les documents pertinents pour des études supplémentaires admissibles et contacté les auteurs et les chercheurs dans le domaine. CRITÈRES DE SÉLECTION: Les essais contrôlés randomisés (ECR) et les essais cliniques contrôlés (ECC) portant sur une intervention chirurgicale ou endovasculaire pour la prise en charge des DAC symptomatiques étaient éligibles. Seules les études avec des anticoagulants ou un traitement antiagrégant plaquettaire comme groupe de contrôle ont été incluses. Deux auteurs de la revue ont prévu d'extraire les données de manière indépendante. RECUEIL ET ANALYSE DES DONNÉES: Les critères de jugement principaux sont l'accident vasculaire cérébral ipsilatéral et le handicap. Les critères de jugement secondaires étaient le décès, tout accident vasculaire cérébral ou accident ischémique transitoire, une sténose résiduelle (50 %), la récurrence de la dissection de l’artère cervicale, un pseudo‐anévrisme en expansion ou une hémorragie importante. Nous avons analysé les études en fonction du premier choix de traitement. Nous avons prévu d'évaluer le risque de biais et d'appliquer les critères GRADE pour toutes les études incluses. RÉSULTATS PRINCIPAUX: Nous n'avons pas trouvé d’ECR achevé ou d’ECC entrepris dans ce domaine de recherche.Aucun ECR ou ECC n'a comparé la chirurgie ou la thérapie endovasculaire avec un groupe témoin. Ainsi, il n'existe pas de données probantes disponibles pour soutenir leur utilisation pour le traitement de la dissection des artères cervicales extracrâniennes en plus de la thérapie antithrombotique chez les personnes qui continuent à avoir des symptômes neurologiques lorsqu'elles sont traitées avec une thérapie antithrombotique seule.La disección arterial cervical (DAC) es una hemorragia o un desgarro patológicos, o ambos, en la pared de las arterias carótidas o vertebrales en su recorrido por el cuello, y es una de las principales causas de accidente cerebrovascular en los jóvenes.Evaluar la efectividad de las intervenciones quirúrgicas y radiológicas versus el mejor tratamiento médico solo para tratar la disección sintomática arterial cervical. MÉTODOS DE BÚSQUEDA: Se hicieron búsquedas exhaustivas en el Registro de ensayos del Grupo Cochrane de Accidentes cerebrovasculares (Cochrane Stroke Group) (última búsqueda en marzo de 2020), el Registro Cochrane central de ensayos controlados (CENTRAL, número 4, 2020), en la Biblioteca Cochrane (búsqueda en marzo de 2020), MEDLINE (1946 hasta marzo de 2020), EMBASE (1974 hasta marzo de 2020). Se realizaron búsquedas de registros relevantes de ensayos en curso y de investigación (búsquedas en marzo de 2020), se comprobaron las referencias de todos los artículos relevantes en busca de otros estudios elegibles y se estableció contacto con los autores e investigadores en el área. CRITERIOS DE SELECCIÓN: Se seleccionaron para inclusión los ensayos controlados aleatorizados (ECA) y los ensayos clínicos controlados (ECC) de intervención endovascular o quirúrgica para el tratamiento de la DAC sintomática. Sólo se incluyeron los estudios con tratamiento anticoagulante o antiplaquetario como grupo control. Dos autores de la revisión planificaron extraer de forma independiente los datos. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Los desenlaces principales fueron el accidente cerebrovascular ipsilateral y la discapacidad. Los desenlaces secundarios fueron la muerte, cualquier accidente cerebrovascular o ataque isquémico transitorio, estenosis residual (50%), reaparición de la disección cervical, expansión del pseudoaneurisma o hemorragia grave. Los estudios se analizaron según el tratamiento de primera elección. Se planificó evaluar el riesgo de sesgo y aplicar los criterios GRADE a los estudios incluidos.No se encontraron ECA ni ECC completados realizados en esta área de investigación.Ningún ECA o ECC comparó la cirugía o el tratamiento endovascular con un control. Por lo tanto, no hay evidencia disponible que respalde su uso para el tratamiento de la disección arterial cervical extracraneal además del tratamiento antitrombótico en personas que continúan con síntomas neurológicos cuando sólo reciben tratamiento antitrombótico.

Background Bipolar disorder is one of the most common serious mental illnesses, affecting approximately 60 million people worldwide. Characterised by extreme alterations in mood, cognition, and behaviour, bipolar disorder can have a significant negative impact on the functioning and quality of life of the affected individual. Compared with the general population, the prevalence of comorbid obesity is significantly higher in bipolar disorder. Approximately 68% of treatment seeking bipolar patients are overweight or obese. Clinicians are aware that obesity has the potential to contribute to other physical health conditions in people with bipolar disorder, including diabetes, hypertension, metabolic syndrome, cardiovascular disease, and coronary heart disease. Cardiovascular disease is the leading cause of premature death in bipolar disorder, happening a decade or more earlier than in the general population. Contributing factors include illness-related factors (mood-related factors, i.e. mania or depression), treatment-related factors (weight implications and other side effects of medications), and lifestyle factors (physical inactivity, poor diet, smoking, substance abuse). Approaches to the management of obesity in individuals with bipolar disorder are diverse and include non-pharmacological interventions (i.e. dietary, exercise, behavioural, or multi-component), pharmacological interventions (i.e. weight loss drugs or medication switching), and bariatric surgery. Objectives To assess the effectiveness of interventions for the management of obesity in people with bipolar disorder. Search methods We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and the Cochrane Central Register for Controlled Trials (CENTRAL) to February 2019. We ran additional searches via Ovid databases including MEDLINE, Embase, and PsycInfo to May 2020. We searched the World Health Organization (WHO) trials portal (International Clinical Trials Registry Platform (ICTRP)) and ClinicalTrials.gov. We also checked the reference lists of all papers brought to full-text stage and all relevant systematic reviews. Selection criteria Randomised controlled trials (RCTs), randomised at the level of the individual or cluster, and cross-over designs of interventions for management of obesity, in which at least 80% of study participants had a clinical diagnosis of bipolar disorder and comorbid obesity (body mass index (BMI) ≥ 30 kg/m²), were eligible for inclusion. No exclusions were based on type of bipolar disorder, stage of illness, age, or gender. We included non-pharmacological interventions comprising dietary, exercise, behavioural, and multi-component interventions; pharmacological interventions consisting of weight loss medications and medication switching interventions; and surgical interventions such as gastric bypass, gastric bands, biliopancreatic diversion, and vertical banded gastroplasty. Comparators included the following approaches: dietary intervention versus inactive comparator; exercise intervention versus inactive comparator; behavioural intervention versus inactive comparator; multi-component lifestyle intervention versus inactive comparator; medication switching intervention versus inactive comparator; weight loss medication intervention versus inactive comparator; and surgical intervention versus inactive comparator. Primary outcomes of interest were changes in body mass, patient-reported adverse events, and quality of life. Data collection and analysis Four review authors were involved in the process of selecting studies. Two review authors independently screened the titles and abstracts of studies identified in the search. Studies brought to the full-text stage were then screened by another two review authors working independently. However, none of the full-text studies met the inclusion criteria. Had we included studies, we would have assessed their methodological quality by using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. We intended to combine dichotomous data using risk ratios (RRs), and continuous data using mean differences (MDs). For each outcome, we intended to calculate overall effect size with 95% confidence intervals (CIs). Main results None of the studies that were screened met the inclusion criteria. Authors' conclusions None of the studies that were assessed met the inclusion criteria of this review. Therefore we were unable to determine the effectiveness of interventions for the management of obesity in individuals with bipolar disorder. Given the extent and impact of the problem and the absence of evidence, this review highlights the need for research in this area. We suggest the need for RCTs that will focus only on populations with bipolar disorder and comorbid obesity. We identified several ongoing studies that may be included in the update of this review.

Background Dementia is a worldwide concern. Its global prevalence is increasing. At present, there is no medication licensed to prevent or delay the onset of dementia. Inflammation has been suggested as a key factor in dementia pathogenesis. Therefore, medications with anti-inflammatory properties could be beneficial for dementia prevention. Objectives To evaluate the effectiveness and adverse effects of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) for the primary or secondary prevention of dementia. Search methods We searched ALOIS, the specialised register of the Cochrane Dementia and Cognitive Improvement Group up to 9 January 2020. ALOIS contains records of clinical trials identified from monthly searches of several major healthcare databases, trial registries and grey literature sources. We ran additional searches across MEDLINE (OvidSP), Embase (OvidSP) and six other databases to ensure that the searches were as comprehensive and up-to-date as possible. We also reviewed citations of reference lists of included studies. Selection criteria We searched for randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing aspirin or other NSAIDs with placebo for the primary or secondary prevention of dementia. We included trials with cognitively healthy participants (primary prevention) or participants with mild cognitive impairment (MCI) or cognitive complaints (secondary prevention). Data collection and analysis We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the strength of evidence for each outcome using the GRADE approach. Main results We included four RCTs with 23,187 participants. Because of the diversity of these trials, we did not combine data to give summary estimates, but presented a narrative description of the evidence. We identified one trial (19,114 participants) comparing low-dose aspirin (100 mg once daily) to placebo. Participants were aged 70 years or older with no history of dementia, cardiovascular disease or physical disability. Interim analysis indicated no significant treatment effect and the trial was terminated slightly early after a median of 4.7 years' follow-up. There was no evidence of a difference in incidence of dementia between aspirin and placebo groups (risk ratio (RR) 0.98, 95% CI 0.83 to 1.15; high-certainty evidence). Participants allocated aspirin had higher rates of major bleeding (RR 1.37, 95% CI 1.17 to 1.60, high-certainty evidence) and slightly higher mortality (RR 1.14, 95% CI 1.01 to 1.28; high-certainty evidence). There was no evidence of a difference in activities of daily living between groups (RR 0.84, 95% CI 0.70 to 1.02; high-certainty evidence). We identified three trials comparing non-aspirin NSAIDs to placebo. All three trials were terminated early due to adverse events associated with NSAIDs reported in other trials. One trial (2528 participants) investigated the cyclo-oxygenase-2 (COX-2) inhibitor celecoxib (200 mg twice daily) and the non-selective NSAID naproxen (220 mg twice daily) for preventing dementia in cognitively healthy older adults with a family history of Alzheimer's disease (AD). Median follow-up was 734 days. Combining both NSAID treatment arms, there was no evidence of a difference in the incidence of AD between participants allocated NSAIDs and those allocated placebo (RR 1.91, 95% CI 0.89 to 4.10; moderate-certainty evidence). There was also no evidence of a difference in rates of myocardial infarction (RR 1.21, 95% CI 0.61 to 2.40), stroke (RR 1.82, 95% CI 0.76 to 4.37) or mortality (RR 1.37, 95% CI 0.78 to 2.43) between treatment groups (all moderate-certainty evidence). One trial (88 participants) assessed the effectiveness of celecoxib (200 mg or 400 mg daily) in delaying cognitive decline in participants aged 40 to 81 years with mild age-related memory loss but normal memory performance scores. Mean duration of follow-up was 17.6 months in the celecoxib group and 18.1 months in the placebo group. There was no evidence of a difference between groups in test scores in any of six cognitive domains. Participants allocated celecoxib experienced more gastrointestinal adverse events than those allocated placebo (RR 2.66, 95% CI 1.05 to 6.75; low-certainty evidence). One trial (1457 participants) assessed the effectiveness of the COX-2 inhibitor rofecoxib (25 mg once daily) in delaying or preventing a diagnosis of AD in participants with MCI. Median duration of study participation was 115 weeks in the rofecoxib group and 130 weeks in the placebo group. There was a higher incidence of AD in the rofecoxib than the placebo group (RR 1.32, 95% CI 1.01 to 1.72; moderate-certainty evidence). There was no evidence of a difference between groups in cardiovascular adverse events (RR 1.07, 95% CI 0.68 to 1.66; moderate-certainty evidence) or mortality (RR 1.62, 95% CI 0.85 to 3.05; moderate-certainty evidence). Participants allocated rofecoxib had more upper gastrointestinal adverse events (RR 3.53, 95% CI 1.17 to 10.68; moderate-certainty evidence). Reported annual mean difference scores showed no evidence of a difference between groups in activities of daily living (year 1: no data available; year 2: 0.0, 95% CI -0.1 to 0.2; year 3: 0.1, 95% CI -0.1 to 0.3; year 4: 0.1, 95% CI -0.1 to 0.4; moderate-certainty evidence). Authors' conclusions There is no evidence to support the use of low-dose aspirin or other NSAIDs of any class (celecoxib, rofecoxib or naproxen) for the prevention of dementia, but there was evidence of harm. Although there were limitations in the available evidence, it seems unlikely that there is any need for further trials of low-dose aspirin for dementia prevention. If future studies of NSAIDs for dementia prevention are planned, they will need to be cognisant of the safety concerns arising from the existing studies.

Cervical artery dissection (CeAD) with an intramural haematoma can lead to stroke risk, especially in young patients. We performed comprehensive searches of the Cochrane Stroke Group Trials Register, the CENTRAL, MEDLINE and EMBASE to review the effectiveness of surgical and endovascular interventions versus best medical treatment alone for symptomatic CeAD. Furthermore, we aim to elaborate on the phenotypic individual disease manifestations of spontaneous Cervical Artery Dissection (sCAD) and how they translate into stroke and risk of dissection recurrence. Primary outcomes were ipsilateral stroke and disability. Secondary outcomes were death, any stroke, or transient ischaemic attack, residual stenosis >50%, recurrence of CeAD, expanding pseudo-aneurysm or major bleeding. Our search yielded no randomised controlled trials and/or controlled clinical trials (CCTs) comparing either carotid surgery or endovascular therapy with optimal medical management; thus there was no evidence to support the use of any specific method for management of extracranial CeAD in patients who fail antithrombotic therapy. However, despite the absence of controlled studies to compare surgery or endovascular therapy in patients who fail antithrombotic therapy, carotid surgery in young patients can be justified as a personalized precision approach given the high morbidity and mortality in this age group.

In Ireland over 36,000 people with dementia live at home cared for by informal carers. Yet often these carers do not know how to deal with cognitive symptoms, including repeated questions wherein ‘truthful’responses cause distress. Carers face a dilemma, do they avoid, distract or ‘correct’ the person and tell the ‘truth’, or lie? This paper explores the concept of lying from the perspective of the carer and person with dementia. A descriptive qualitative methodology was used. Focus groups with a purposive sample of people with memory problems (n = 14) and carers (n = 18) were conducted. The results found that deliberate lying with the intention to deceive was deemed unacceptable by all. However, in certain circumstances telling a ‘good lie’ or ‘white lie’ was considered acceptable when the carer knew the person and the intention behind the ‘lie’ was to mitigate the distress of the person with dementia.

Objective: A common symptom of cognitive decline in people living with dementia, or people with memory problems, the cause of which has not yet been diagnosed, is the person repeatedly asking for loved ones who are deceased or making statements that are incorrect. Carers are then faced with a dilemma, do they avoid and distract or ‘correct’ the person and tell the ‘truth’, or tell a lie. This paper explores the concept of lying from the perspective of people living with dementia in the community and their informal/unpaid carers. Methods: A descriptive qualitative study utilising focus groups to collect the data was conducted. Three focus group’s with a purposive sample of people with memory problems (n ¼ 14) and three focus group’s with informal/unpaid carers (n ¼ 18) were undertaken. Qualitative content analysis was used to analyse the data. Results: All participants considered that blatant lying with the intention to deceive and do harm is not acceptable. However, telling a ‘good lie’ or ‘white lie’ to alleviate distress was in certain circumstances considered acceptable. The intention behind the ‘lie’ in their view had to be to do good, and the informal/unpaid carer telling the lie had to really ‘know the person’ and be cognisant of family preferences. Some informal/unpaid carers acknowledged that it may be acceptable for health care professionals to tell a ‘good lie’ or ‘small lie’ in certain circumstances. However, health professionals need to ‘know the person’ and need to consider informal/family caregivers’ wishes. Conclusion: Lying was only considered acceptable in the context of knowing the person and when done with the intention not to harm or deceive, undertaken with empathy, and only for the purpose of mitigating the person living with dementia’s distress. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was commissioned by the Centre for Ageing Research and Development in Ireland (CARDI) which is now the Ageing Research and Development Division of the Institute of Public Health in Ireland (IPH). peer-reviewed

Background: Older adults are frequent users of Emergency departments (ED) and this trend will continue due to population ageing and the associated increase in healthcare needs. Older adults are vulnerable to adverse outcomes following ED discharge. A number of heterogeneous interventions have been developed and implemented to improve clinical outcomes among this cohort. A growing number of systematic reviews have synthesised evidence regarding ED interventions using varying methodologies. This overview aims to synthesise the totality of evidence in order to evaluate the effectiveness of interventions to reduce adverse outcomes in older adults discharged from the ED. Methods: To identify relevant reviews, the following databases will be searched: Cochrane Database of Systematic reviews, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Databases of Abstracts of Reviews of Effects, PubMed, MEDLINE, Epistemonikos, Ageline, Embase, PEDro, Scopus, CINAHL and the PROSPERO register. The search for grey literature will include Open Grey and Grey Literature Reports. Systematic reviews of randomised controlled trials will be analysed to assess the effect of ED interventions on clinical and process outcomes in older adults. Methodological quality of the reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 tool. The review will be reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Summary of findings will include a hierarchical rank of interventions based on estimates of effects and the quality of evidence. Discussion: This overview is required given the number of systematic reviews published regarding the effectiveness of various ED interventions for older adults at risk of adverse outcomes following discharge from the ED. There is a need to examine the totality of evidence using rigorous analytic techniques to inform best care and potentially develop a hierarchy of treatment options. PROSPERO registration: CRD42020145315 (28/04/2020)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of surgical and radiological interventions versus best medical treatment alone for treating symptomatic cervical artery dissection.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of intermittent pneumatic compression for treatment of individuals with critical limb ischaemia.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of endovascular repair versus open surgical repair for the treatment of complicated chronic type B aortic dissection.

Background A dissection of the aorta is a separation or tear of the intima from the media. This tear allows blood to flow not only through the original aortic flow channel (known as the true lumen), but also through a second channel between the intima and media (known as the false lumen). Aortic dissection is a life-threatening condition which can be rapidly fatal. There is debate on the optimal surgical approach for aortic arch dissection. People with ascending aortic dissection have poor rates of survival. Currently open surgical repair is regarded as the standard treatment for aortic arch dissection. We intend to review the role of hybrid and open repair in aortic arch dissection. Objectives To assess the effectiveness and safety of a hybrid technique of treatment over conventional open repair in the management of aortic arch dissection. Search methods The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 8 February 2021. We also undertook reference checking for additional studies. Selection criteria We included randomised controlled trials (RCTs) and clinical controlled trials (CCTs), which compared the effects of hybrid repair techniques versus open surgical repair of aortic arch dissection. Outcomes of interest were dissection-related mortality and all-cause mortality, neurological deficit, cardiac injury, respiratory compromise, renal ischaemia, false lumen thrombosis (defined by partial or complete thrombosis) and mesenteric ischaemia. Data collection and analysis Two review authors independently screened all records identified by the literature searches to identify those that met our inclusion criteria. We planned to undertake data collection and analysis in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to assess the certainty of the evidence using GRADE. Main results We identified one ongoing study and two unpublished studies that met the inclusion criteria for the review. Due to a lack of study data, we could not compare the outcomes of hybrid repair to conventional open repair for aortic arch dissection. Authors' conclusions This review revealed one ongoing RCT and two unpublished RCTs evaluating hybrid versus conventional open repair for aortic arch surgery. Observational data suggest that hybrid repair for aortic arch dissection could potentially be favourable, but conclusions can not be drawn from these studies, which are highly selective, and are based on the clinical status of the patient, the presence of comorbidities and the skills of the operators. However, a conclusion about its definitive benefit over conventional open surgical repair cannot be made from this review without published RCTs or CCTs. Future RCTs or CCTs need to have adequate sample sizes and follow-up, and assess clinically-relevant outcomes, in order to determine the optimal treatment for people with aortic arch dissection. It must be noted that this may not be feasible, due to the reasons mentioned.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of endovascular repair versus conventional open surgical repair (OSR) used in the management of thoracoabdominal aorta aneurysms (TAAAs).

Background Thoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is greater than the risk of surgical complications. Depending on the cause, size and growth rate of the TAA, treatment may vary from close observation to emergency surgery. Aneurysms of the thoracic aorta can be managed by a number of surgical techniques. Open surgical repair (OSR) of aneurysms involves either partial or total replacement of the aorta, which is dependent on the extent of the diseased segment of the aorta. During OSR, the aneurysm is replaced with a synthetic graft. Hybrid repair (HR) involves a combination of open surgery with endovascular aortic stent graft placement. Hybrid repair requires varying degrees of invasiveness, depending on the number of supra-aortic branches that require debranching. The hybrid technique that combines supra-aortic vascular debranching with stent grafting of the aortic arch has been introduced as a therapeutic alternative. However, the short- and long-term outcomes of HR remain unclear, due to technical difficulties and complications as a result of the angulation of the aortic arch as well as handling of the arch during surgery. Objectives To assess the effectiveness and safety of HR versus conventional OSR for the treatment of TAAs. Search methods The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 22 March 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations. Selection criteria We considered for inclusion in the review all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing HR to OSR for TAAs. Data collection and analysis Two review authors independently screened all titles and abstracts obtained from the literature search to identify those that met the inclusion criteria. We retrieved the full text of studies deemed as potentially relevant by at least one review author. The same review authors screened the full-text articles independently for inclusion or exclusion. Main results No RCTs or CCTs met the inclusion criteria for this review. Authors' conclusions Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of HR compared to OSR in people with TAAs, and we are unable to provide high-certainty evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs are necessary, addressing the objective of this review.

Traditional therapeutic options for complex thoracoabdominal aneurysm include open repair, hybrid repair or endovascular repair (involving fenestrated or branched endografts). The Streamliner Multilayer Flow Modulator has been available for treatment of thoracoabdominal aneurysms since 2010. Its design permits blood flow to perfuse through the mesh in a modus that preserves collateral branch patency, while modulating turbulent to laminar flow within the device. The flow then stagnates over time within the surrounding aneurysm sac. Significant complications, including paraplegia, renal failure and cerebrovascular accident, are much lower with Streamliner Multilayer Flow Modulator treatment. Application of the Streamliner Multilayer Flow Modulator to complex aortic pathologies presents a novel solution to an, as of yet, unmet clinical need, and has resulted in promising clinical outcomes when compared to existing solutions. The Streamliner Multilayer Flow Modulator offers potential for treatment of thoracoabdominal aortic pathologies in patients and is not just confined to those with complexity that dictates no other management options. While current literature illustrates that there is a decreased risk of mortality and associated complications when this new disruptive technology is utilised, there is still a need for prospective, long-term clinical trials, as well as comparative trials to accurately assess outcomes of Streamliner Multilayer Flow Modulator treatment that are both precise and reproducible. This article is a review of current clinical literature regarding contemporary flow modulating technology compared with open, branched and fenestrated managements, presenting early outcomes.

Aims and objectives To understand people with dementia, staff and relatives perspectives on reminiscence, its impact on their lives and experience of care and care giving. Background The quality of life of people with dementia living in long-term care is an important question for providers and policymakers. Reminiscence is thought to have potential for increasing resident–staff interaction, thereby contributing to enhanced personhood for people with dementia. Relatively little is known about the effects of reminiscence on people with dementia or staff. Design This is a grounded theory study. This design was chosen because of its focus on understanding people's behaviour, interaction and response to events. Methods In-depth interviews were conducted with residents with dementia (n = 11), relatives (n = 5), healthcare assistants (n = 10), nurses (n = 9) and nurse managers (n = 3). Results Reminiscence enabled staff to see and know the person beneath the dementia. It acted as … a key revealing the person to staff, enabling them to engage with the person with dementia in a different way. Knowing the person enabled staff to understand (through the lens of the person's past) and sometimes to accommodate the person's current behaviour. Conclusion The theory of ‘seeing me (through my memories)’ was generated from the data. This theory explains that through reminiscing and engaging with the person with dementia, staff begin to see the person (their personhood) through the mirror of their memories. Relevance to clinical practice This study found that reminiscence enhanced the experience of living in long-term care for residents with dementia and working in long-term care settings for staff.

Background There is increasing recognition of the potential use of reminiscence in maintaining or improving the quality of life of people with dementia. Despite being used widely in dementia care, evidence on the effectiveness of reminiscence remains uncertain. Aims This study aims to evaluate the effectiveness of a structured education-based reminiscence programme—the Dementia Education Programme Incorporating Reminiscence for Staff—for people with dementia residing in long-stay care settings in Ireland. Methods Dementia Education Programme Incorporating Reminiscence for Staff is a two-group, single-blind, cluster randomised trial conducted in long-stay residential care settings in Ireland. The primary outcome was the self-rated quality of life of residents as measured by the Quality of Life—Alzheimer's Disease instrument. Results Using an intention-to-treat analysis, we found that the estimated effect of the intervention on the quality of life of residents was a non-significant 3.54 (p = 0.1; 95% confidence interval −0.83, 7.90), expressed as the difference in mean improvement between the intervention and control groups. However, the per-protocol analysis yielded a significant effect for the intervention on the quality of life of residents of 5.22 (p = 0.04; 95% confidence interval 0.11, 10.34). Conclusions Reminiscence may, in certain circumstances, be an effective care option for people with dementia in long-stay settings with potential to impact positively on the quality of life of residents. Copyright © 2014 John Wiley & Sons, Ltd.

Aims and objectives This paper describes the steps used in developing and piloting a structured education programme – the Structured Education Reminiscence-based Programme for Staff (SERPS). The programme aimed to prepare nurses and care assistants to use reminiscence when caring for people with dementia living in long-term care. Reminiscence involves facilitating people to talk or think about their past. Background Structured education programmes are used widely as interventions in randomised controlled trials. However, the process of developing a structured education programme has received little attention relative to that given to evaluating the effectiveness of such programmes. This paper makes explicit the steps followed to develop the SERPS, thereby making a contribution to the methodology of designing and implementing effective structured education programmes. Design The approach to designing the SERPS was informed by the Van Meijel et al. (2004) model (Journal of Advanced Nursing 48, 84): (1) problem definition, (2) accumulation of building blocks for intervention design, (3) intervention design and (4) intervention validation. Methods Grounded theory was used (1) to generate data to shape the ‘building blocks’ for the SERPS and (2) to explore residents, family and staff's experience of using/receiving reminiscence. Results Analysis of the pilot data indicated that the programme met its objective of preparing staff to use reminiscence with residents with dementia. Staff were positive both about the SERPS and the use of reminiscence with residents with dementia. Conclusions This paper outlines a systematic approach to developing and validating a structured education programme. Participation in a structured education programme is more positive for staff if they are expected to actively implement what they have learnt. Ongoing support during the delivery of the programme is important for successful implementation. Relevance to clinical practice The incorporation of client and professional experience in the design phase is a key strength of this approach to programme design.

Chronic diseases cause complex challenges and difficulties for patients, families and health professionals. With the increasing prevalence of chronic diseases, long-term treatment interventions may be required. Health professionals must empower patients to adhere to therapies and develop self-management strategies. The aetiology of bladder and bowel dysfunctions is multi-dimensional with some individuals who present with chronic disease being predisposed to urinary or faecal incontinence. This article will discuss the concepts of compliance, adherence and concordance approaches in the management of bladder and bowel dysfunction, focusing on the concept of self-management approaches to enhance patients' adherence to treatment regimens and maximise therapeutic outcomes.

This is the protocol for a review and there is no abstract. The objectives are as follows:The objective of this systematic review is to evaluate the effectiveness of aspirin and other NSAIDs in the primary and secondary prevention of dementia.

This paper is a report of an analysis of the concept of reminiscence in dementia and highlights its uses as a therapeutic intervention used on individuals with dementia. No single definition of reminiscence exists in healthcare literature; however, definitions offered have similar components. The term life review is commonly used when discussing reminiscence; however, both terms are quite different in their goals, theory base and content. This concept analysis identified reminiscence as a process which occurs in stages, involving the recalling of early life events and interaction between individuals. The antecedents of reminiscence are age, life transitions, attention span, ability to recall, ability to vocalise and stressful situations. Reminiscence can lead to positive mental health, enhanced self esteem and improved communication skills. It also facilitates preparation for death, increases interaction between people, prepares for the future and evaluates a past life. Reminiscence therapy is used extensively in dementia care and evidence shows when used effectively it helps individuals retain a sense of self worth, identity and individuality.

It is essential to understand the experience of living with dementia from the perspective of the person with dementia so that services can be appropriately constructed. This review paper, drawing on prior work, identifies key strategies for the meaningful inclusion of persons with dementia within qualitative research studies, it examines the articulation of these strategies and shares how these strategies were operationalised within one national research study in Ireland. Strategies within the literature were categorised and then synthesized into a guide consisting of four main areas; gaining COnsent, maximizing Responses, Telling the story, and Ending on a high (CORTE). The CORTE guideline was used to as a tool for analysing relevant research reports. CORTE is a synthesized account of grouped strategies that could be used to maximize the meaningful involvement of persons with dementia and can also provide a guide for reporting the strategies used so that researchers can learn from each other.

There is increasing recognition of the potential use of reminiscence in maintaining or improving the quality of life of people with dementia. Despite being used widely in dementia care, evidence on the effectiveness of reminiscence remains uncertain.This study aims to evaluate the effectiveness of a structured education-based reminiscence programme-the Dementia Education Programme Incorporating Reminiscence for Staff-for people with dementia residing in long-stay care settings in Ireland.Dementia Education Programme Incorporating Reminiscence for Staff is a two-group, single-blind, cluster randomised trial conducted in long-stay residential care settings in Ireland. The primary outcome was the self-rated quality of life of residents as measured by the Quality of Life-Alzheimer's Disease instrument.Using an intention-to-treat analysis, we found that the estimated effect of the intervention on the quality of life of residents was a non-significant 3.54 (p = 0.1; 95% confidence interval -0.83, 7.90), expressed as the difference in mean improvement between the intervention and control groups. However, the per-protocol analysis yielded a significant effect for the intervention on the quality of life of residents of 5.22 (p = 0.04; 95% confidence interval 0.11, 10.34).Reminiscence may, in certain circumstances, be an effective care option for people with dementia in long-stay settings with potential to impact positively on the quality of life of residents.

Background Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036. Psychosocial interventions, such as reminiscence, have the potential to improve the quality of life of people with dementia. However, while reminiscence is used widely in dementia care, its impact on the quality of life of people with dementia remains largely undocumented and there is a need for a robust and fair assessment of its overall effectiveness. The DementiA education programme incorporating REminiscence for Staff study will evaluate the effectiveness of a structured reminiscence-based education programme for care staff on the quality of life of residents with dementia in long-stay units. Methods/Design The study is a two-group, single-blind cluster randomised trial conducted in public and private long-stay residential settings in Ireland. Randomisation to control and intervention is at the level of the long-stay residential unit. Sample size calculations suggest that 18 residential units each containing 17 people with dementia are required for randomisation to control and intervention groups to achieve power of at least 80% with alpha levels of 0.05. Each resident in the intervention group is linked with a nurse and care assistant who have taken the structured reminiscence-based education programme. Participants in the control group will receive usual care. The primary outcome is quality of life of residents as measured by the Quality of Life-AD instrument. Secondary outcomes include agitation, depression and carer burden. Blinded outcome assessment is undertaken at baseline and at 18-22 weeks post-randomisation. Discussion Trials on reminiscence-based interventions for people with dementia have been scarce and the quality of the information arising from those that have been done has been undermined by methodological problems, particularly in relation to scale and scope. This trial is powered to deliver more credible and durable results. The trial may also convey process utility to a long-stay system in Ireland that has not been geared for education and training, especially in relation to dementia. The results of this trial are applicable to long-stay residential units in Ireland and internationally. Trial registration Current Controlled Trials ISRCTN99651465